Aging-in-Place and the Value of Audiology

A few months ago, I was privileged to participate in a practice development seminar sponsored by Professor Amyn Amlani and his Au.D. students at the University of North Texas. It was great to see a university offer several hours of content on such important matters as coding & reimbursement, labor economics and how to charge for rehabilitation services. It was an honor for me to be included on a docket consisting of the likes of Barry Freeman, Deb Abel and Harvey Abrams. I can only be hopeful other universities sponsor more workshops and seminars devoted to practice development, and local audiologists are invited to not only attend, but to present. Likewise, I am confident most of you would agree we need more of this type of productive interaction between academic and private practice audiologists.

Among the many things I learned while waiting my turn to speak was the concept of “aging-in-place.” I’ve heard the term healthy aging, but aging-in-place was a new one for me. Since it piqued my curiosity, I had to learn more about what this term meant. The Center for Disease Control defines aging-in-place as “the ability to live in one’s own home and community safely, independently, and comfortably, regardless of age, income, or ability level.” Most adults, of course, would prefer to age in place; in fact, 78 percent of adults between the ages of 50 and 64 report that they would prefer to stay in their current residence as they age. One-third of American households are home to one or more residents 60 years of age or older. Additionally, those who are not able to age in place, and are therefore institutionalized, become drains on the current healthcare system, and put increasing strain on the currently struggling programs of Medicare and Medicaid. In fact, the CDC estimates that, in the year 2002, Medicare spent an average of $9,113 to $13,507 on injuries related to falls. As Genther et al (2013) recently demonstrated, adults with hearing loss have a higher rate of hospitalization and poorer overall health. This data represents an enormous opportunity for audiologists to play a crucial role in the efficient delivery of services that maintain a higher quality of life for a large and growing number of people.

Considering the growing aging-in-place population and the fact that nearly two out of every three adults over the age of 70 have hearing loss, audiologists certainly have a large role to play in the aging-in-place movement. As an doctorate level audiologist you have the credentials to differentiate what you do from big-box retailers and over-the-counter operators. The question really is how you can do this. In no particularly order, here are three things you can do to set your practice apart from the competition as you attempt to attract patients who have the desire to age-in-place. All are designed to provide a more personalized touch, which is something the big-box competitors cannot duplicate.

Use a comprehensive needs assessment tool that doubles as a real-world measure of outcome. My favorite tool for this job is the TELEGRAM. The TELEGRAM is a communication assessment tool developed several years ago by Dr. Linda Thibodeau of the Callier Center at the University of Texas-Dallas. It allows the patient and provider to collaboratively list and rate on a 1 to 5 scale more than a dozen discrete listening situations that may be problematic for hearing impaired individuals. Of note to patients who want to age-in-place is your ability to work with the patient to prioritize and rate situations like door bells, smoke alarms as well as other alerting devices. Notice that the “A” of TELEGRAM is “alerting,” thus allowing you the ability to list and rate listening situations where alerting in important. Just as important, the TELEGRAM can be re-administered 2 to 4 weeks after the fitting to see if your recommendation made a difference in everyday listening situations.

Figure 1. TELEGRAM assessment tool.

Private practitioners, especially those in smaller practices, realize the absolute importance of word-of-mouth referrals. As Kim Rawn points out in her article in this issue of AP, top performers more effectively engage in programs that systemically generate word-of-mouth referrals. In today’s digital age social media is used to amplify referrals generated through traditional word-of-mouth channels. According to Dr. Ferris Timini, Director of Social Media at Mayo Clinic, using social media is the third most common on-line activity and the group joining Facebook and Twitter fastest are people over the age of 65. Furthermore, the website, reports that 60% of social media users are likely to share a posting from a “doctor”, which was the highest ranking of all groups to choose from by a wide margin. These trends clearly suggest that doctors of audiology need to be present on social media, personalizing their content for their patients and community. Luckily, there are dashboards out there, like the one shown in Figure 2, that help you deliver a consistent and personal message to your followers on Facebook and Twitter.

Figure 2. Example of a social media dashboard that allows you to manage and post personal messages.

Use motivational interviewing techniques to move patients through the stages of change associated with hearing loss of adult onset. I am convinced that this form of counseling cannot be easily duplicated by professionals more concerned with hitting a monthly sales objective, rather than providing personalized patient care. It takes a skilled, caring professional to gently nudge many patients toward changing their behavior. And, this notion seems to be doubly important for patients that are oftentimes desperately trying to avoid losing their independence. I think it takes a lifetime to truly master motivational interviewing, but even relative novices can benefit from incorporating it into their clinical routine (Pantalon, 2011).

Patients, even those that want to age-in-place, have many alternatives when it comes to hearing care. This abundance of choice is a good thing for consumers. It’s up to doctors of audiology to have the discipline to put new ideas, like some of these three mentioned here into practice. The real value of a doctor of audiology is providing highly personalized care to all patients, including those that want to age-in-place. A by-product of this endeavor is greater professional autonomy and financial rewards.    

Genther, D. JAMA. Association of Hearing Loss With Hospitalization and Burden of Disease in Older Adults. June 12, 2013, 309, 22.

Pantalon, M. Instant Influence! How to get anyone to do anything fast. 2011, Little, Brown Co, NY.